An obese 35-year-old housekeeper presents with low back pain and requests an X-ray. She has had this pain off and on for several years; however, for the past 2 days, it is worse than it has ever been. It started after she vigorously vacuumed a rug, is primarily on the right lower side, radiates down her posterior right thigh to her knee, but is not associated with any numbness or tingling. It is relieved by lying flat on her back with her legs slightly elevated and lessened somewhat when she takes ibuprofen 400 mg.
Except for moderate obesity and difficulty maneuvering onto the examination table because of pain, her examination is fairly normal. The only abnormalities you note are a positive straight leg raise test, with raising the right leg eliciting more pain than the left. Her strength, sensation, and deep tendon reflexes in all extremities are normal. What is the likely diagnosis…
